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Year : 2017  |  Volume : 11  |  Issue : 2  |  Page : 208-214

Integration of simulation in postgraduate studies in Saudi Arabia: The current practice in anesthesia training program

1 Consultant and Assistant Professor, Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
2 Consultant and Assistant Professor of Pediatric Anesthesia and Critical Care Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
3 Consultant, Department of Anesthesia, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
4 Consultant, Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia
5 Cardiac Anesthesiologist, Department of Anesthesia, King Fahad Specialist Hospital Dammam, Saudi Arabia
6 Consultant and Assistant professor, Department of Anesthesia, King Saud university, Riyadh, Saudi Arabia
7 Consultant, Department of Anesthesiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
8 Consultant and Associate Professor, Department of Anesthesia and Critical Care, Director, Clinical Skills and Simulation Center, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

Correspondence Address:
Abdulaziz Boker
Clinical Skills and Simulation Center, Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1658-354X.203059

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Date of Web Publication27-Mar-2017


The educational programs in the Saudi Commission for Health Specialties are developing rapidly in the fields of technical development. Such development is witnessed, particularly in the scientific areas related to what is commonly known as evidence-based medicine. This review highlights the critical need and importance of integrating simulation into anesthesia training and assessment. Furthermore, it describes the current utilization of simulation in anesthesia and critical care assessment process.

Keywords: Anesthesia training; medical education; Saudi Arabia; simulation

How to cite this article:
Arab A, Alatassi A, Alattas E, Alzoraigi U, AlZaher Z, Ahmad A, Albabtain H, Boker A. Integration of simulation in postgraduate studies in Saudi Arabia: The current practice in anesthesia training program. Saudi J Anaesth 2017;11:208-14

How to cite this URL:
Arab A, Alatassi A, Alattas E, Alzoraigi U, AlZaher Z, Ahmad A, Albabtain H, Boker A. Integration of simulation in postgraduate studies in Saudi Arabia: The current practice in anesthesia training program. Saudi J Anaesth [serial online] 2017 [cited 2022 Jan 25];11:208-14. Available from:

  Introduction Top

Simulation is an applicable and safe solution to overcome risk that could be encountered by both learners and teachers during training in the high-risk industries such as nuclear and aviation. It is considered as a core component of their training, certification, and maintenance of license for both institutions and individuals.[1] Adaptation of over 90 years' experience in other fields (military, aviation, astronauts, nuclear industry, etc.) proved simulation's value and has begun the adoption and adaptation by health care.[2]

Simulation-based medical education enables knowledge, skills, and attitudes to be acquired for all health-care professionals in a safe, educationally orientated, and efficient manner.[1] Postgraduate medical education for technical skills had been completely informal - until the introduction of simulation technologies and methodologies.[2] Simulation-based medical training programs traced back to the late 1960s and early 1970s, in the University of Miami where Harvey was developed. Harvey was the cardiology patient simulator, a hybrid between a sophisticated task trainer and computer-enhanced manikin simulator.[3]

A major challenge for medical undergraduates is the application of theoretical knowledge to the management of patients. Some medical schools in the Middle East have changed their curricula and adopted such educational strategies as problem-based learning. Furthermore, many medical schools have started to utilize clinical skills' laboratories for training. However, simulation-based learning is not yet well established in this region.[4] Worldwide, simulation has been widely used for the acquisition of specific clinical skill in specialties such as pediatrics, emergency medicine, intensive care medicine, obstetrics, anesthesia, radiology, and allied medical sciences.[5],[6]

Simulation-based education (SBE) can help the current situation in at least two dimensions. First, SBE promotes the implementation of competency-based medical education principles by fostering performance of key needed skills for all members within teams. Second, SBE enables the integration of patient safety principles within the existing training and assessment domains of the current training program. Furthermore, it will aid reaching the needed cultural awareness to promote the application of safety-oriented practices upon graduation from the program.[7] Simulation provides many new advantages: objectively measuring both technical and nontechnical skills performance, setting proficiency “benchmarks” that insure a minimum standard is measured and achieved before patient care begins, and retraining when a physician has a prolonged absence or testing new devices before initial use on patients.[2]

In an era of patient safety and quality of care, accompanied by public pressure and extreme shortage of qualified anesthesiologists, our practice in Saudi Arabia calls for immediate reform to provide safer and better health care for patients.[8]The educational programs in the Saudi Commission for Health Specialties (SCFHS) are evolving and developing rapidly in the fields of technical development. Such development is witnessed, particularly in the scientific areas related to what is commonly known as evidence-based medicine. The Scientific Board for Anesthesia and Critical Care reviewed the applicable international experiences and guidelines in the field of simulation to develop a staged program that provides the optimal use of best practice for the local training and assessment. A program that can also foresee and incorporate these new technologies in the field of licensing and maintenance of certification for anesthesia practitioners.

In the last year, several meetings and workshops were hold by the simulation subcommittee at the SCFHS anesthesia and critical care scientific board with the aim to provide a roadmap for integrating the use of medical simulation in anesthesia training, assessment, and practice. It also aimed to transfer this experience as a contribution to other national medical specialties under the umbrella of the SCFHS. This work aimed to highlight the critical need and importance of integrating simulation into anesthesia training and assessment and to describe the current utilization of simulation in anesthesia and critical care assessment process.

  Simulation-related Activities in Saudi Arabia Top

The International Conference on Advanced Clinical Simulation was held in Prince Sultan Military College of Health Sciences, Dhahran, KSA, in October 2014. The conference provided a forum for academicians, administrators, and health-care professionals to discuss the current and projected SBE practices. An expert panel discussion was held to identify considerations for establishing a state-of-art simulation center. These considerations were the planning stage, stakeholders' involvement, strategic planning, center design, partnership development, faculty development, curriculum development, and establishing a research strategy.[9] Later on, the Ministry of Health (MOH) sponsored the first Saudi Health Simulation Conference in Riyadh, June 9, 2015, to June 11, 2015. The SCFHS was among the sponsors of the conference, as both MOH and SCFHS are playing an active role in the introduction of simulation in postgraduate residents' training.[10] In addition, the academic institutions had the central role in introducing, developing, and applying new training modalities such as SBE to health care in Saudi Arabia.[11]

There are many studies conducted in Saudi Arabia regarding the usage of simulation in undergraduate medical curriculum. They aimed to describe the extent of its use, its efficacy in achieving the intended learning as well as satisfaction of both teacher and students with simulation.[12],[13],[14],[15] On the other hand, scarce, if any, studies were conducted on the usage of simulation in postgraduate curricula. There was one meta-analysis Saudi study conducted on the use of simulators for teaching laparoscopic surgery skills among junior surgical residents. It showed a significant enhancement and improvement at a cognitive as well as psychomotor level.[16] More recently, a Saudi systematic review of the literature was conducted to evaluate simulation in training for arthroscopic knee surgery.[17]

Alghamdi in another Saudi study has presented the idea and design of an interactive simulation in radiological education.[18] A recent Saudi study conducted to assess the impact of acute stress on psychomotor bimanual performance during a simulated tumor resection task. It showed that acute stress initiated by simulated severe intraoperative bleeding significantly decreases bimanual psychomotor performance during the acute stressful episode.[19] These researches conducted on the medical simulation in Saudi Arabia demonstrate a positive prompt response to the call for establishing a research strategy in simulation, one of the recommendations of the International Conference on Advanced Clinical Simulation held in Dhahran, KSA, 2014.[9]

  Using Simulation in Anesthesiology Top

Anesthesiology is one of the hands-on specialties, in which the only way to master a skill is to practice it again and again.[20] Anesthesiology trainees relied, in the past, on the apprenticeship model and spontaneous exposure to patient cases to gain expertise in managing the high-stakes situations and life-threatening events. Academic anesthesiologists adopted the simulation-based training to supplement this experiential learning using full-body manikins [21] training models such as crisis resource management (CRM)[22] and assessment of nontechnical skills.[23] Rare conditions, such as difficult airway management and malignant hyperthermia, can be imitated to give trainees practice in patient management before encountering these challenges in a clinical context.[24] In other words, simulation provides a safe learning environment where anesthesiology residents and students can be taught, practice, and be evaluated on technical skills such as intubation and ventilation without ever putting a real patient at risk.[20]

  Current Practice of Simulation in Anesthesia Residency Training Program Top

In the curriculum of Anesthesia Residency Training Program, task-training hands-on workshops and low- or moderate-to-high fidelity simulation are used during training. To ensure effective engagement of simulation in Anesthesia Residency Training Program, the minimal standards for simulation-based workshops were set. These standards included defining the minimal fidelity that is needed to run the workshop, the minimal workshop instructor qualification, and the minimal required competency in every workshop. These workshops are fully specified as seen in [Table 1]. The competencies set were according to what was described by Miller [25] and showed in [Figure 1]. All anesthesia residents are expected to participate and complete these workshops to successfully obtain their Final In-Training Evaluation Report.
Table 1: Simulation-assisted courses and workshops included in the curriculum of anesthesia residency training program

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Figure 1: Level of competencies to be acquired by the trainee according to Miller 1990

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Among the simulation-assisted courses and workshops included in the curriculum of Anesthesia Residency Training Program are difficult airway management and crisis management which represents the most widespread use of simulation in anesthesiology.[26] The effectiveness of using the high fidelity AirSim Bronchi airway simulator to teach residents how to manage lung isolation with double-lumen ETT and bronchial blockers was studied by Failor et al.[27] They reported that resident confidence scores for each lung isolation technique improved after the simulation training, with the median gain ranging from 0.5 to 1.5. The largest improvement occurred with the bronchial blockers.

When it came to the fidelity of the simulation, low to high fidelity simulation was in the simulation-assisted courses and workshops included in the curriculum of Anesthesia Residency Training Program. A recent meta-analysis of 14 studies looking at the benefit of using high fidelity model for advanced life support training showed no significant improvement over low fidelity models with regard to either the skills or the knowledge.[28] Although it is often assumed that the high fidelity simulator gives a richer training experience. However, this might not always be true. This also depends on a large part of the objective the educators are trying to achieve.[29] The key is to use the appropriate fidelity model based on the expected educational and learning objectives.[30] In a recent meta-analysis of advanced airway management simulation training, Kennedy et al., 2014, reported an increase in learner satisfaction, improved skills, and patient outcomes but not knowledge in simulation compared with nonsimulation interventions.[31]

Before enrolling in the simulation-based training programs, the residents should successfully complete, with adequate competency, the life support courses as appropriate according to the pertaining regulations. These courses include basic life support, advanced cardiac life support, pediatric advanced life support, neonatal resuscitation program, advanced trauma life support, and fundamental critical care courses seen in [Figure 2].
Figure 2: Sequence of Anesthesia Residency Training Program. FITER: Final In-Training Evaluation Report, BLS: Basic life support, ACLS: Advanced cardiac life support, PALS: Pediatric advanced life support, NRP: Neonatal resuscitation program, ATLS: Advanced trauma life support, FCCS: Fundamental critical care courses, SBTP: Simulation-based training programs

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The simulation trainer, instructor/facilitator of the simulation-based workshops, should be attended at least three courses under the supervision of an expert facilitator and should be evaluated for their knowledge, skills, and attitude by trainees and facilitators using both checklist and observation. On the other hand, renewal of certificate of the trainers in simulation required either running two full simulation courses/year or repeat the train the trainer or advanced course each 3 years.

  Simulation-based Assessment Top

Simulation is the artificial recreation of a clinical environment or circumstance for the purpose of allowing a learner to undertake a specific task in a controlled manner that presents no risk to patients. Simulation can recreate many clinical settings with a degree of realism, allowing educators to observe how individuals and teams may perform in the “real world.” It is particularly useful in assessing learner performance of a complete procedure, or in crisis situations that might not commonly be encountered or managed independently during a finite residency.[32]

There are several studies assessing the reliability and validity of simulation-based assessment. Most of these studies showed positive results regarding the reliability and validity of simulation-based assessment when compared to traditional assessment methods.[33],[34],[35] On the other hand, few studies showed some variability in reliability, especially on evaluating the behavioral aspects. The validity of simulation-based assessments to differentiate a large group of trainees based on clinical experience or training was confirmed in a previous study.[36] Hence, during the coming years, the role of simulation as a training and evaluation tool in anesthesiology is expected to grow.

The currently used types of simulation techniques included standardized patients, virtual simulation, computer-based simulation, full-body manikins high fidelity simulation, and hybrid simulation. Recently, simulation plays an essential role in the assessment process. Simulation-based assessment tools utilized to assess the different technical skills included log book, direct observation with or without criteria, global rating scales (GRSs), and direct observation procedural skills. Best approaches are to combine a checklist with GRS to be able to identify strengths and weakness during the performance of any procedure.[37]

On the other hand, the nontechnical skills: the cognitive, social, and personal skills that complement the technical skills and contribute to safe and efficient task performance should be also assessed.[38]

These nontechnical skills are recognized as crucial to good anesthetic practice.[39] Good nontechnical skills (e.g., vigilance, anticipation, clear communication, and team coordination) can reduce the likelihood of error and consequently of accidents.[23] A taxonomy of nontechnical skills was developed under the umbrella of NHS Education Scotland in 1999. A team of anesthetists and psychologists was assembled to design an anesthetists' nontechnical skills (ANTS) system using series of task analyses based on a literature review, observations, interviews, surveys, and incident analysis.[25]

Examples of some tools that measure such skill are CRM and ANTS assessment.[23] The later measures performance in four areas: situational awareness, task management including fatigue and stress, decision-making and leadership, and communication. The ANTS assessment also needs a comprehensive training for the faculty and to familiarize the trainee with it before its introduction.[23],[40] The Scottish Clinical Simulation Centre develops courses that focus on the development of the nontechnical skills which are directly relevant to anesthetic practice. The emphasis is on the use of nontechnical skills in routine practice to avoid errors and adverse events, but the courses also illustrate the importance of such skills in the management of emergency situations.[23]

The ANTS system was introduced to the UK after the members of the Educational Strategy Group of the Royal College of Anesthetists agreed to apply the system to a whole School of Anesthesia in 2003.[41] There has been considerable interest in the use of ANTS by anesthetists in other countries including India, the USA, German Canada, Spain, Sweden, the Netherlands, Australia, Italy, and Denmark.[42],[43],[44]

A 5-year plan aiming to integrate simulation-based station into the MOCK/Final OSCE was prepared to be implemented between 2014 and 2018 [Table 2]. It included also the aimed type of simulation as well as the appropriate assessment tool. Throughout the time frame, both candidates and examiners will be prepared for the final assessment
Table 2: Integration of simulation-based stations into the assessment process

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  Application of Simulation in Anesthesia Licensing and Maintenance of Certification Top

Anesthesia specialty worldwide is currently facing two major challenges included: increased public awareness of anesthesia-related complications as well as the heterogeneous training and practice which possess a continuous threat on patient safety. These changes might persist in the future. The American Board of Anesthesiology had developed a solution to face such challenges by introducing simulation-based Maintenance of Certification in Anesthesiology program.[45]

Currently, in Saudi Arabia, participation of simulation-based continuous medical education activity is encouraged to be licensed or recertified as anesthetist, but it is still optional. Encouragement could be enhanced by doubling of accredited CME hours for simulation-based session

  Accreditation of Simulation Centers Top

Simulation is becoming an integral part of the accreditation process in several medical disciplines.[46],[47] Accreditation process of the simulation centers in Saudi Arabia, and the trainer licensing in each center is a crucial step after the introduction of simulation into training, assessment, and licensing. This process will be the responsibility of the SCFHS. Currently, the scope of accreditations included three main domains simulation environment, workforce, and operation plan [Figure 3].
Figure 3: Scope of accreditation process of the simulation centers set by the Saudi Commission for Health Specialties

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  Conclusion Top

A roadmap for integrating the use of medical simulation in anesthesia training, assessment, and practice was effectively prepared by the SCFHS. Many steps of this roadmap were taken, and many steps are pending. Many efforts are needed to complete this fruitful journey.


The authors would like to acknowledge the support of the Saudi Commission for Health Specialties (SCFHS), Anesthesia and Critical Care Board members for their support.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, et al. Training and simulation for patient safety. Qual Saf Health Care 2010;19 Suppl 2:i34-43.  Back to cited text no. 1
Satava RM. Role of simulation in postgraduate medical education. J Health Spec 2015;3:12-6.  Back to cited text no. 2
  [Full text]  
Gordon MS. Cardiology patient simulator. Development of an animated manikin to teach cardiovascular disease. Am J Cardiol 1974;34:350-5.  Back to cited text no. 3
Al-Elq AH. Simulation-based medical teaching and learning. J Family Community Med 2010;17:35-40.  Back to cited text no. 4
Cherry RA, Ali J. Current concepts in simulation-based trauma education. J Trauma 2008;65:1186-93.  Back to cited text no. 5
McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 2011;86:706-11.  Back to cited text no. 6
Weller JM, Nestel D, Marshall SD, Brooks PM, Conn JJ. Simulation in clinical teaching and learning, practicing clinical skills and teamwork in a safe environment. MEJA 2012;196:1-5.  Back to cited text no. 7
Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press; 2000. p. 300-10.  Back to cited text no. 8
Lababidi H, Al-Jubran KM, AlAhmari MD, AlZahrani EM, Nestel D, Terzioglu F, et al. Establishing a clinical simulation centre: Recommendations from an expert panel from the International Conference on Advanced Clinical Simulation, Dhahran, Saudi Arabia. J Health Spec 2015;3:212-5.  Back to cited text no. 9
  [Full text]  
Ware J, Lababidi H. Saudi simulation. J Health Spec 2015;3:137-8.  Back to cited text no. 10
  [Full text]  
Lababidi H. Author's reply to Saudi simulation. J Health Spec 2016;4:68-9.  Back to cited text no. 11
  [Full text]  
Al-Mously N, Baalash A, Salem R, Mukaddam S. The proper timing to introduce simulation-based education in internal medicine clerkship. J Contemp Med Educ 2014;2:180-4.  Back to cited text no. 12
Nuzhat A, Salem RO, Al Shehri FN, Al Hamdan N. Role and challenges of simulation in undergraduate curriculum. Med Teach 2014;36 Suppl 1:S69-73.  Back to cited text no. 13
Agha S, Alhamrani AY, Khan MA. Satisfaction of medical students with simulation based learning. Saudi Med J 2015;36:731-6.  Back to cited text no. 14
Ahmed S, Al-Mously N, Al-Senani F, Zafar M, Ahmed M. Medical teachers' perception towards simulation-based medical education: A multicenter study in Saudi Arabia. Med Teach 2016;38 Suppl 1:S37-44.  Back to cited text no. 15
Marei HF, Al-Jandan BA. Simulation-based local anaesthesia teaching enhances learning outcomes. Eur J Dent Educ 2013;17:e44-8.  Back to cited text no. 16
Hetaimish B, Elbadawi H, Ayeni OR. Evaluating simulation in training for arthroscopic knee surgery: A systematic review of the literature. Arthroscopy 2016;32:1207-20.e1.  Back to cited text no. 17
Alghamdi AA. Simulation system for radiology education integration of physical and virtual realities: Overview and software considerations. J Health Spec 2015;3:144-52.  Back to cited text no. 18
  [Full text]  
Bajunaid K, Mullah MA, Winkler-Schwartz A, Alotaibi FE, Fares J, Baggiani M, et al. Impact of acute stress on psychomotor bimanual performance during a simulated tumor resection task. J Neurosurg 2016;11:71-80.  Back to cited text no. 19
Castanelli DJ. The rise of simulation in technical skills teaching and the implications for training novices in anaesthesia. Anaesth Intensive Care 2009;37:903-10.  Back to cited text no. 20
Cooper JB, Taqueti VR. A brief history of the development of mannequin simulators for clinical education and training. Qual Saf Health Care 2004;13 Suppl 1:i11-8.  Back to cited text no. 21
Howard SK, Gaba DM, Fish KJ, Yang G, Sarnquist FH. Anesthesia crisis resource management training: Teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med 1992;63:763-70.  Back to cited text no. 22
Flin R, Maran N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care 2004;13 Suppl 1:i80-4.  Back to cited text no. 23
Lorello GR, Cook DA, Johnson RL, Brydges R. Simulation-based training in anaesthesiology: A systematic review and meta-analysis. Br J Anaesth 2014;112:231-45.  Back to cited text no. 24
Miller GE. The assessment of clinical skills/competence/performance. Acad Med 1990;65 9 Suppl:S63-7.  Back to cited text no. 25
Green M, Tariq R, Green P. Improving patient safety through simulation training in anesthesiology: Where are we? Anesthesiol Res Pract 2016;2016:4237523.  Back to cited text no. 26
Failor E, Bowdle A, Jelacic S, Togashi K. High-fidelity simulation of lung isolation with double-lumen endotracheal tubes and bronchial blockers in anesthesiology resident training. J Cardiothorac Vasc Anesth 2014;28:865-9.  Back to cited text no. 27
Cheng A, Lockey A, Bhanji F, Lin Y, Hunt EA, Lang E. The use of high-fidelity manikins for advanced life support training – A systematic review and meta-analysis. Resuscitation 2015;93:142-9.  Back to cited text no. 28
Nyssen AS, Larbuisson R, Janssens M, Pendeville P, Mayné A. A comparison of the training value of two types of anesthesia simulators: Computer screen-based and mannequin-based simulators. Anesth Analg 2002;94:1560-5.  Back to cited text no. 29
Schaumberg A. The matter of 'fidelity': Keep it simple or complex? Best Pract Res Clin Anaesthesiol 2015;29:21-5.  Back to cited text no. 30
Kennedy CC, Cannon EK, Warner DO, Cook DA. Advanced airway management simulation training in medical education: A systematic review and meta-analysis. Crit Care Med 2014;42:169-78.  Back to cited text no. 31
Bandiera G, Sherbino J, Frank JR. The CanMEDS Assessment Tools Handbook. An Introductory Guide to Assessment Methods for the CanMEDS Competencies. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2006. p. 36-8.  Back to cited text no. 32
Devitt JH, Kurrek MM, Cohen MM, Fish K, Fish P, Noel AG, et al. Testing internal consistency and construct validity during evaluation of performance in a patient simulator. Anesth Analg 1998;86:1160-4.  Back to cited text no. 33
Mudumbai SC, Gaba DM, Boulet JR, Howard SK, Davies MF. External validation of simulation-based assessments with other performance measures of third-year anesthesiology residents. Simul Healthc 2012;7:73-80.  Back to cited text no. 34
Blum RH, Boulet JR, Cooper JB, Muret-Wagstaff SL; Harvard Assessment of Anesthesia Resident Performance Research Group. Simulation-based assessment to identify critical gaps in safe anesthesia resident performance. Anesthesiology 2014;120:129-41.  Back to cited text no. 35
Devitt JH, Kurrek MM, Cohen MM, Cleave-Hogg D. The validity of performance assessments using simulation. Anesthesiology 2001;95:36-42.  Back to cited text no. 36
Boulet JR, Murray DJ. Simulation-based assessment in anesthesiology: Requirements for practical implementation. Anesthesiology 2010;112:1041-52.  Back to cited text no. 37
Gaba DM, Fish KJ, Howard SK. Crisis Management in Anesthesiology. 1st ed. New York: Churchill Livingstone; 1994. p. 264.  Back to cited text no. 38
Crossingham GV, Sice PJ, Roberts MJ, Lam WH, Gale TC. Development of workplace-based assessments of non-technical skills in anaesthesia. Anaesthesia 2012;67:158-64.  Back to cited text no. 39
Flin R, Patey R, Glavin R, Maran N. Anaesthetists' non-technical skills. Br J Anaesth 2010;105:38-44.  Back to cited text no. 40
Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R. Anaesthetists' Non-Technical Skills (ANTS): Evaluation of a behavioural marker system. Br J Anaesth 2003;90:580-8.  Back to cited text no. 41
Trabucco G, Procaccio F, Marcanti M. Non-technical skills in organ procurement. A preliminary approach to communicative and emotional problems in the Intensive Care Unit. Organs Tissues Cells 2008;3:197-204.  Back to cited text no. 42
Divekar D. Nontechnical skills in anaesthesiology. Pravara Med Rev 2009;1(2):1-10.  Back to cited text no. 43
Steadman RH. Improving on reality: Can simulation facilitate practice change? Anesthesiology 2010;112:775-6.  Back to cited text no. 44
Levine AI, Flynn BC, Bryson EO, Demaria S Jr. Simulation-based Maintenance of Certification in Anesthesiology (MOCA) course optimization: Use of multi-modality educational activities. J Clin Anesth 2012;24:68-74.  Back to cited text no. 45
Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Med Teach 2005;27:10-28.  Back to cited text no. 46
DeMaria S Jr., Levine AI, Bryson EO. The use of multi-modality simulation in the retraining of the physician for medical licensure. J Clin Anesth 2010;22:294-9.  Back to cited text no. 47


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2]


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